Re: Did I just run out of milk?

OK a quick online search of health websites is showing me that is recommended that physicians "consider" waiting until 6 weeks postpartum to prescribe Depo shot. Interesting. So your doctor was being properly cautious! But my understanding has always been that it is not ok at any time during breastfeeding (assuming there are other options that work for the mothere in question-sometimes there are not) due to the risk to milk production. Stay tuned....

Re: Did I just run out of milk?

Yeah, Kellymom says Depo is L1 (safest for lactation) when administered 6-8 weeks postpartum, but L4 (known to be hazardous) if given before that point, and notes that there is at least good anecdotal evidence of Depo and other progestin-only contraceptives decreasing milk supy even when used appropriately: http://kellymom.com/bf/can-i-breastf.../birthcontrol/

I think the approach advocated by kellymom is the right one: try progestin-only pills first, and if they have a negative effect then you absolutely avoid methods like Depo or Mirena which are difficult or impossible to discontinue.

This all being said, I do know someone who had the Depo shot within a few days of giving birth and nevertheless successfully breastfed her baby. Everyone is different!

Re: Did I just run out of milk?

Wow, I am really unhappy about this cause I was told it was totally ok. Yes I had the shot at about 6-7 weeks, was almost 2 weeks ago i think. I for sure wont get the next dose then. What is ok to take while breastfeeding? I feed her on demand all the time and always have really but now am kind of freaking out about if i was right to worry that nothing seems to come out when i try to express. i will start watching her diapers..6-8 a day right wet or wet with poop ok also?we have a three day holiday coming up here should i get a can of formula or something to have at the house in case it gets worse. this is awful!

Re: Did I just run out of milk?

I hope this doesnt mess us up terribly, my husband is calling a medical line to ask now also. pills have never worked for me as birth control but id rather just use condoms then mess up my milk supply for the baby.

Re: Did I just run out of milk?

OK so I am going to have to eat my words from the earlier post. I have read the section on hormonal birth control in Breastfeeding Answers Made Simple and it appears that your doctors advice was not wrong, as far as existing research/recommendations on birth control methodology suggests. Yes it appears that hormonal birth control affects breastmilk production particularly in the early weeks postpartum, and depo is a real problem due to fact it is injected and lasts so long. But studies are not conclusive about if this then changes breastfeeding duration outcomes. Basically, this is an area of controversy, scientifically.

On the other hand, according to BAMS again, "Progestin and estrogen, the hormones used in hormonal methods, are considered compatible with breastfeeding (AAP,2001). But the World Health Organization, the Academy of Breastfeeding Medicine, and other health organizations consider these methods second and third choices for the breastfeeding mother because small amounts of these hormones pass into the milk, and during the early months of life, a baby is least able to metabolize and excrete both natural and synthetic steroids (Kennedy, 2010, WHO, 2004). There is also the possibility that estrogen and progestin may undermine optimal breastfeeding by decreasing milk production although this has not been confirmed by research. (Truitt, Fraser, Grimes, Gallo, and Schulz, 2003a; Truitt, Fraser, Grimes, Gallo, and Schulz, 2003b)
Some experts recommend that hormonal methods be discouraged in some specific situations, such as when mother or baby has health issues, the baby is younger than 6 weeks (progestin only methods) or 6 months (methods containing estrogen), the mother has confirmed milk production problems, multiple births, or her baby was born preterm (Labbok, 2007).” Quote from page 499 of Breastfeeding Answers made Simple, Mohbacher, 2010

So....what does that mean to you? I think it means you don’t have nearly as much to worry about as I thought initially, BUT, again, I think mommals suggestions to watch closely are correct. As far as your bc choices going forward, I think that since you suspected something was affecting your milk production shortly after receiving your depo shot, that, if hormone based methods can be safely avoided by you, it might make sense to try something else for now, or maybe try a progestin only method.

Re: Did I just run out of milk?

By the way, if you are wondering if the fact that small amounts of the homomes might get into your milk mean you should stop nursing, the answer is definitely to KEEP NURSING. The alternative is much much much much much more potentially harmful.

Re: Did I just run out of milk?

Have you gotten your period? If not,-and it would be odd so early- you already have one natural bc method working already. Lactation Amenorrhea Method (LAM) is in place WHEN
1) Mother has not gotten her period yet (defined as 2 or more consecutive days of bleeding after 8 weeks post partum)
2) Baby is exclusively breastfed on cue (no regular supplements of any kind, not even water, no undue scheduling of meals so baby nurses less frequently than normal)
3) Baby is under 6 months old

If all of these conditions are met, you are already doing LAM.
LAM already gives you at least 98% protection against pregnancy according to studies from around the world. I do not know if or how taking hormonal bc might affect this, however.
Condoms have always worked just fine in my case.

Re: Did I just run out of milk?

Yes, please don't freak out! More than likely you've experienced a NORMAL adjustment to supply, which is unrelated to your use of the Depo shot. Your doctor's advice was not exactly wrong... Just very lacking in nuance, IMO. Your doc said "Yes, Depo is safe for breastfeeding," and that is backed up by plenty of studies. But if your doc had said "Yes, many studies suggest that Depo is safe for breastfeeding, but there are anecdotal reports of moms experiencing reduced supply when taking hormonal contraceptives, and this is a non-reversible method so if you happen to have a problem, there's no going back," would you have chosen this method? Or would you have looked for something else?

I really don't think you need to run out and buy formula, even with the 3 day holiday coming up. Just nurse, nurse, nurse, nurse, nurse. And watch diaper output. According to Kellymom.com, after 6 weeks you are looking for 4-5 sopping wet diapers per day (or a greater number of less wet diapers, depending on how often you change your baby), and baby may continue to poop many times a day or may decrease poop frequency to as little as one (usually quite large) poop every 7-10+ days (see http://kellymom.com/bf/got-milk/supp...ughmilk-older/).

The are plenty of contraceptives that work just great while nursing. LLLMeg mentioned LAM, but you can also use all the barrier methods (male condom, female condom, diaphragm, cervical cap, sponge, and contraceptive jellies or films), and of course the "self-control" methods like withdrawal (surprisingly effective when the male partner has good control), abstinence (a real popular one! ), and outercourse. If you want a hormonal method, then my personal first choice would be the progestin-only mini-pill, because it is so easy to discontinue use if you suspect you have a problem with it. My second choice would be Mirena, which is progestin-only and implanted in the uterus; its effects are supposed to be more localized than a systemic contraceptive like the mini-pill. The big drawback is that if you're one of the women who has a problem with Mirena, you're stuck with it until you get an appointment to have it removed. I think it is best to avoid the combination estrogen-progestin methods (the pill, e.g. Ortho-Tricyclen and its generic competitors, the vaginal ring, and the patch), because there is good evidence that combination methods do decrease supply.

Re: Did I just run out of milk?

Thanks again for looking into this all with me, I find this site very helpful especially in my situation. We basically got the same info from this new medical line number we just got from our insurance. No formula, just going to nurse. She also recommended that we invest or rent a baby scale to have here at home. This way ( since I freak out and worry so easily ) I can weigh her daily if I want and even before and after a feed in the same outfit/diaper etc. This should give me some peace of mind when it comes to the "do I have enough milk" question and also the "is she keeping enough down with her spitting up" question. I still do not plan on having the shot again until I stop breastfeeding. By the time it becomes ineffective she will already be about 5 months old and we plan to breastfeed for the first year. We will find another less intrusive method such as condoms and will make do with that until we are finished just to be safe and keep me from worrying so much about it.

Re: Did I just run out of milk?

OK just remember it is normal for baby to gain in fits and starts, not an exact amount every day. Also a 'normal' nursing session could be anywhere from about an ounce to four ounces of intake. Baby will not take in the same amount each session normally. In other words, if the scales helps you feel more confident great, but I have seen frequent weight checks work against moms confidence as well. If you are not happy with the numbers, I suggest seeing a Board Certified lactation consultant (IBCLC) before assuming anything is really wrong.